title: [Mortality risk factors for bloodstream infections caused by extended-spectrum beta-lactamase-producing microorganisms].
abstract: OBJECTIVE
  To identify risk factors for mortality in patients with bloodstream infection by extended-spectrum beta-lactamase (ESBL)-producing microorganisms.
  
  
  METHODS
  A retrospective study in patients with bloodstream infection by ESBL-producing microorganisms from January 2000 to December 2006 was carried out.
  
  
  RESULTS
  A total of 4,172 bloodstream infections were identified, 1,218 (29.2%) and 226 (5.4%) of which were caused by Escherichia coli and Klebsiella pneumoniae, respectively. The overall mortality rate was 50.9% in patients with bacteriema due to ESBL-producing strains. The binomial logistic regression model, adjusted for age and severity, identified admission to an intensive care unit (OR 38,631; 95%CI:3,375-424,618; P=.002) and a SAPS II severity index score >30 in the 24-48 h before obtaining blood culture (OR 17,980; 95% CI:2,193-170,439; P=.010) as factors associated to mortality, while the urinary tract as primary site of infection was an independent determinant for non-mortality (OR 0.184; 95% CI:0.034-0.975; P=.047).
  
  
  CONCLUSIONS
  Patients with suspicion of bacteriema who have been admitted to the ICU with a score of elevated severity should be candidates for early empirical treatments as they have a greater risk of mortality. However, the benefit of this strategy may be limited due to the baseline severity of the patient.
authors.affiliation: Hospital del Mar, Barcelona, España. 94007@imas.imim.es
authors.forename: O
authors.initials: O
authors.lastname: Ferrández
authors.forename: S
authors.initials: S
authors.lastname: Grau
authors.forename: P
authors.initials: P
authors.lastname: Saballs
authors.forename: S
authors.initials: S
authors.lastname: Luque
authors.forename: R
authors.initials: R
authors.lastname: Terradas
authors.forename: E
authors.initials: E
authors.lastname: Salas
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases